- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $6,456.54
| Facility | | $1,445.44 | $3,630.78 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,047.13 / $2,754.23
| Professional | | $891.25 | $1,047.13 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,630.78 / $15,135.61
| Facility | | $1,905.46 | $3,630.78 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,548.82 / $7,413.10
| Professional | | $891.25 | $1,548.82 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $3,235.94
| Professional | | $1,819.70 | $2,041.74 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,047.13 / $6,456.54
| Facility | | $954.99 | $1,047.13 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,288.25 / $2,691.53
| Professional | | $512.86 | $1,288.25 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,995.26 / $7,079.46
| Facility | | $812.83 | $1,995.26 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,479.11 / $2,137.96
| Professional | | $1,047.13 | $1,479.11 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $5,011.87 / $13,182.57
| Facility | | $776.25 | $5,011.87 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,778.28 / $2,754.23
| Professional | | $1,000.00 | $1,778.28 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $1,513.56
| Professional | | $1,513.56 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,630.78 / $15,135.61
| Facility | | $1,905.46 | $3,630.78 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,548.82 / $7,413.10
| Professional | | $891.25 | $1,548.82 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,370.32 / $13,182.57
| Facility | | $1,584.89 | $5,370.32 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,513.56 / $2,951.21
| Professional | | $933.25 | $1,513.56 | $2,951.21 |